Safety of High-Dose IVF Treatments Questioned

A growing number of fertility specialists are questioning the practice of using high doses of hormone medications to help women become pregnant, calling instead for low-dose cycles of in-vitro fertilization that carry less of a risk of potentially serious side effects. The New York Times reports:

[Ovarian Hyperstimulation Syndrome (OHSS)] is a little-known complication of fertility treatments that rely on high doses of hormones, which are standard in the United States and the United Kingdom; the syndrome is not the only health problem to be linked to in vitro fertilization. Fertility clinics in Europe and Japan have turned to a safer, low-dose form of IVF, but clinics here have largely resisted on the grounds that the success rates for low-dose IVF are not as high.

“Pregnancy rates are lower, and more cycles of IVF are necessary” with low-dose IVF, said Dr. Glenn L. Schattman, a fertility doctor at NewYork-Presbyterian/Weill Cornell Medical Center and president of the Society for Assisted Reproductive Technology.

But some critics are urging the industry to reconsider.

“Mild stimulation is clearly much healthier for women,” said Francine Coeytaux, founder of the Pacific Institute for Women’s Health, a nonprofit organization based in Los Angeles. “The reason hyper-stimulation happened is because these fertility clinics compete against each other by posting their success rates.”

In high-dose IVF, a woman is first given injections of a drug, often Lupron, to suppress her ovaries, causing temporary menopausal symptoms. Then the ovaries are stimulated with hormones, such as follicle-stimulating hormone and luteinizing hormone, in order to produce more eggs. The duration of stimulation is longer, and the hormone dose significantly higher, than in the low-dose programs common overseas.

Women normally generate one egg per cycle, but high-dose stimulation can help women produce 20 to 30 eggs, or even more. By contrast, women receiving mild, low-dose IVF produce 8 to 10 eggs. The ovaries are not suppressed at the outset, and there is no manipulation of the patient’s cycle.

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